Within the management of respiratory diseases, some patients tend to receive, as part of the treatment, the placement of an artificial airway system (whether it is an orotracheal tube or a tracheostomy cannula) which are indicated in such cases wherein having an available airway is required, whether, among other reasons, because the upper airways are obstructed or injured, or due to the health condition of the patient it is required, or to guarantee an artificial airway for some undetermined time. Upon placing the artificial airway, the physiological functions of the glottis (vocal chords) are altered, which are directly related with voice generation and ventilation; in this last process the vocal cords widen during inspiration to allow passage of air through the airways and narrow down during exhalation, which allows for a pause at the end of the inspiration, this generates positive pressure inside the lungs favoring air redistribution through the alveolar units, which improves lung ventilation, prevents and reduces atelectasis levels (lung collapse). Is due to these alterations that these types of patients, routinely, require or are benefitted by strategies that let them improve their lung capacity by means of lung re-expansion techniques.
A lung re-expansion technique is defined as any maneuver which temporarily increases alveolar pressure above normal ventilation and maintains that pressure beyond normal time. The exercises for lung re-expansion are carried out by taking sustained maximum inspirations by means of a short apnea at the end of inspiration, followed by a slow passive exhalation.
The techniques for lung re-expansion serve the purpose of effectively expanding the lungs. In order to accomplish this goal, diverse techniques are used, called lung re-expansion techniques, which can be divided in two: manual or non-instrumental techniques (techniques or commands given to the patient by the care giver or health professional) and instrumental techniques (which require the use of medical devises or instruments).
Amongst the instrumental techniques there are various devises used to generate lung re-expansion, amongst which there are: mechanical ventilators, manual resuscitators and respiratory incentives (volumetric or by flow) and others. Mechanical ventilators (such as Servo 900, Servo I, Puritan Benett, Bipap and Cpap, and others) are used to provide “non-invasive mechanical ventilation”. Mechanical ventilators work under the positive pressure principle, which causes the risk of generating pressure or volume induced trauma. They work alone, in a programmed manner, but depend on electric energy or batteries. They are mainly used in the acute stages of the diseases; the patients can remain days or even weeks connected to them and as the patient improves his health condition, they are disconnected, by means of the patient's very own recovery aided, in a case basis, by the respiratory incentive or by non-instrumental techniques of lung re-expansion (verbal commands that ease the patients to hold air inside their lungs for a few seconds at the end of the inspiration).
Manual resuscitators, on their side, are self-inflatable bags used to provide positive pressure during resuscitation maneuvers, but their use is very common in patients with an artificial airway, in acute phases, since they provide all the respiratory support the patient requires. The manual resuscitator, which is costly compared with the incentive, but much cheaper in comparison to the ventilators, works under the positive pressure principle, i.e. it requires to be manipulated by someone pressing the bag so the air enters the lung, generating the risk of volume or pressure induced trauma (although some of them have a pressure release valve, which makes them more costly), they lack an occlusion system for inspired flow, because of which it makes no pause at the end of the inspiration.
The volume or flow respiratory incentives are used in patients that can breathe through the mouth. In order to couple them for a tracheotomy, the replace the nozzle placing a “T adapter with a one-way valve”. The T adapter, with one-way valve is designed to make micro-nebulization in patients with an artificial airway and because of this reason they do not achieve the lung re-expansion. The respiratory incentives in patients with an artificial airway currently in existence do not make a pause at the end of the inspiration, they do not have an occlusion/release system or a pressure release valve.
There is another type of respiratory incentives which difference lays in that the latter a makeshift T is placed with a one-way valve (used for nebulization in patients with an artificial airway). But this manner of applying the technique does not allow to extend the pause at the end of the inspiration.
The T device with a one-way valve, a flow occlusion/release system, and a pressure release valve proposed in the proposed intervention makes part of the category of respiratory incentives and solves all the problems that up to this moment exist in this class of devices.